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ABSTRACT: Neuroendocrine tumours (NETs) located in the gastrointestinal tract have had an increased incidence during the past 10 years. Well-differentiated tumour formations located in the small intestine have a slow evolution, with the patients being asymptomatic in the early stages and accidental diagnosis in most cases. Annual ultrasound screening and other procedures are essential in the detection of malignant tumours in the early stages.
In this paper we report the case of a 55-year-old female patient, with total thyroidectomy performed in 2010 for a papillary thyroid carcinoma, currently undergoing replacement therapy with Euthyrox (75µg / day), asymptomatic. During the ultrasound monitoring of some pre-existing liver haemangiomas, a solid formation was highlighted, vascularised at the level of the last ileal loop. Laboratory tests presented normal values, excepting serum serotonine level which was significantly increased. The investigations after the ultrasound, namely, the colonoscopy with examination of the terminal ileum on about 30 cm, PET-CT scan (positron emission tomography/computed tomography), morphological results correlated with the immunophenotypic ones (CHROMO, Synaptophysin, Ki67), have led to the diagnosis of a G1 neuroendocrine tumour located in the terminal ileum. At the same time, the PET-CT scan also showed a left lung nodule, minimally metabolically active, for which excision was recommended, in order to establish the certain diagnosis between a primary formation and a secondary metastasis.
In our case, in the absence of ultrasound annual monitoring of known liver haemangiomas, the neuroendocrine tumor located in the terminal ileum, would have been diagnosed in advanced stages, when the therapeutic management and the follow-up would have been difficult. Also, due to the fact that many years ago, the patient had a papillary thyroid carcinoma and endocrine malignancies are related to the appearance of NETs, the issue of the existence of a connection between the two types of neoplasms occurs.
